Cardiac MR assessment of aortic regurgitation: Holodiastolic flow reversal in the descending aorta helps stratify severity

Michael A. Bolen, Zoran B. Popovic, Prabhakar Rajiah, Ruvin S. Gabriel, Andrew O. Zurick, Michael L. Lieber, Scott D. Flamm

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Abstract

Purpose: To assess the utility of holodiastolic flow reversal (HDR) in the descending aorta on velocity-encoded cardiac magnetic resonance (MR) images in the stratification of aortic regurgitation (AR) severity. Materials and Methods: This study was approved by the institutional review board, with waiver of informed consent. A total of 80 patients (overall mean age, 49 years ± 18 [standard deviation]; 22 women and 58 men ) with clinical indication for cardiac MR imaging of the aorta were analyzed retrospectively. Velocity-encoded MR imaging was used to quantify AR and assess for HDR at the level of the middescending aorta. These indexes were compared with a qualitative integrated echocardiographic evaluation of AR severity. Sensitivity and specificity for HDR in the prediction of substantial AR were determined, and logistic regression analysis (with associated odds ratios and C statistics) was performed, with HDR and regurgitant fraction as independent predictors. An additional 42 patients (overall mean age, 48 years ± 21; 12 female and 30 male ) were then prospectively evaluated in similar fashion to evaluate a decision model derived from analysis of the first group. Results: HDR predicted severe AR (echo grade, 4) with high sensitivity (100%) and specificity (93%). HDR was highly specifi c (100%) but had lower sensitivity (61%) for moderate to severe AR (echo grade, 3-4). Integration of HDR and direct AR quantification into a combined stratification model based on analysis of the primary group showed good predictive results in the validation group, with a C statistic of 0.94 for moderate to severe AR and 0.93 for severe AR. Conclusion: HDR in the middescending thoracic aorta observed at cardiac MR is indicative of severe AR and can be used in conjunction with quantified regurgitant values obtained from velocity-encoded MR imaging to stratify AR severity.

Original languageEnglish (US)
Pages (from-to)98-104
Number of pages7
JournalRadiology
Volume260
Issue number1
DOIs
Publication statusPublished - Jul 1 2011

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Bolen, M. A., Popovic, Z. B., Rajiah, P., Gabriel, R. S., Zurick, A. O., Lieber, M. L., & Flamm, S. D. (2011). Cardiac MR assessment of aortic regurgitation: Holodiastolic flow reversal in the descending aorta helps stratify severity. Radiology, 260(1), 98-104. https://doi.org/10.1148/radiol.11102064